Provider Demographics
NPI:1770331241
Name:PHILLIPS, HAVEN LANAE (LMSW)
Entity type:Individual
Prefix:
First Name:HAVEN
Middle Name:LANAE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4843 AL HIGHWAY 144
Mailing Address - Street 2:
Mailing Address - City:RAGLAND
Mailing Address - State:AL
Mailing Address - Zip Code:35131-4613
Mailing Address - Country:US
Mailing Address - Phone:256-282-8194
Mailing Address - Fax:
Practice Address - Street 1:1 PERIMETER PARK S STE 100N
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35243-3248
Practice Address - Country:US
Practice Address - Phone:205-936-2356
Practice Address - Fax:205-273-5033
Is Sole Proprietor?:No
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6503G1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical